Stress tests in cardiology practice in the conditions of the Lipetsk Regional Clinical Hospital.

STRESS ECHOCARDIOGRAPHY

Stress echocardiography (stress echocardiography) is a fusion of two methods: EchoCG and load ECG, where the priority method of evaluation is EchoCG (echocardiography, ultrasound examination of the heart). The main prerequisite underlying the method was the fact that the occurrence of myocardial ischemia is accompanied by a violation of contractile function. A change in myocardial contractility develops following a decrease in blood flow, a violation of metabolism and diastolic function, but before the appearance of changes on the ECG and an attack of angina pectoris. If the violation of the myocardial blood supply is transient, then the emerging pathological movement of the left ventricular wall serves as a marker for determining the localization and severity of ischemia.

Stress echocardiography allows not only to more accurately identify myocardial ischemia, but also to detail the pool of the stenosed coronary artery, to determine the viability of the myocardium in the post-infarction zone.

In the Lipetsk Regional Clinical Hospital, stress EchoCG is carried out with a pharmacological load (with dobutamine) in a hospital setting.

Dobutamine increases oxygen consumption by the myocardium and in the absence of adequate blood supply (hemodynamically significant damage to the coronary arteries) provokes myocardial ischemia.

Preparation:

1. Cancellation of beta-blockers in 48-72 hours, nitrates in 24 hours (on the recommendation of a cardiologist).
2. It is mandatory to have with you the results of ECG, echocardiography (echocardiography, ultrasound of the heart), if available - the results of daily ECG monitoring, a towel.

Indications:

1. Diagnosis of coronary heart disease.
2. Determination of prognosis and risk in patients with an established diagnosis (after myocardial infarction).
3. Determination of the cause of shortness of breath.
4. Evaluation of the results of myocardial revascularization.
5. Determination of the localization of myocardial ischemia.
6. Assessment of the severity of valvular stenosis.
7. Pain-free depression of the ST segment, questionable results or contraindications to conducting tests with physical activity.
8. Identification of a viable myocardium after a heart attack, determination of the severity of coronary artery damage, evaluation of therapy results.
9. Complete blockade of the left leg of the Gis beam.
10. Hypertrophy of the left ventricle with a change in the terminal part of the ventricular complex on an ECG.
11. The presence of an electrocardiostimulator or WPW (Wolf-Parkinson-White) syndrome in the patient.
12. ECG changes in women that can be interpreted as ischemic.

Contraindications:

1. Pronounced rhythm and conduction disturbances.

The course of the study.

Dobutamine is administered stepwise at intervals of 3 minutes in increasing doses. The essence of the test is to assess the contractility of the segments of the left ventricle after each stage of the test. ECG and blood pressure indicators are monitored throughout the entire sample.

After the study, the doctor evaluates the data obtained and gives a conclusion:

• negative test - in the absence of areas of violation of local contractility of the left ventricular myocardium;
• a positive test is carried out when areas of violation of local contractility of the left ventricular myocardium are detected;
• an uninformative test is a test during which the required heart rate is not reached.

Prepared:

Head of the Department of Functional Diagnostics Natalia Viktorovna Zaikina
Doctor of the Department of Functional Diagnostics Litvinenko Svetlana Aleksandrovna